Provider Demographics
NPI:1063512051
Name:SOUTHARK EMS, LLC
Entity Type:Organization
Organization Name:SOUTHARK EMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-853-4800
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71646-0127
Mailing Address - Country:US
Mailing Address - Phone:870-853-4800
Mailing Address - Fax:
Practice Address - Street 1:908 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:AR
Practice Address - Zip Code:71646-2722
Practice Address - Country:US
Practice Address - Phone:870-853-4800
Practice Address - Fax:870-881-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4913416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00150820OtherRAILROAD MEDICARE
AR47384Medicare ID - Type UnspecifiedMEDICARE